What is individual and Group physician or practice?

Individual Healthcare Practitioners 

Individual healthcare practitioners are physicians and nonphysician practitioners who render medical services to Medicare beneficiaries and submit claims for the services rendered. These practitioners must complete Form CMS-855I.

Those individual healthcare practitioners who bill the Medicare carrier directly for their services will be issued their own individual PIN. The address tied to the PIN is usually the physician ’ s bill- ing/mailing address, which may differ from his or her physical address where medical services are rendered. Many carriers can maintain two addresses in the provider address file. Medicare may verify a new provider ’ s address by contacting the post office, by a personal visit, or by other means.

Physician-Directed Group/Clinic Practice 

A physician-directed group/clinic may be a partnership, association, or corporation composed of physicians or nonphysician practitioners who wish to bill Medicare as a unit. The group must com- plete Form CMS-855B.

If a physician wishes to file claims as part of a group/clinic, the group/clinic must request a group/clinic PIN number for billing purposes. Each local carrier issues it ’ s own group/clinic PINs, so number formats will vary by carrier.

The group/clinic PIN makes the group unique when filing ser- vices to the local carrier. The address tied to the PIN is usually the group/clinic ’ s billing or mailing address, which may differ from the physical address. Many carriers can maintain two addresses in the provider address file. Medicare may verify a new group ’ s address by contacting the post office, by a personal visit, or by other means. Reassignment of Benefits : Each member within the group/clinic must complete an Individual

Reassignment of Benefits, Form CMS-855R, stating they agree to turn all monies over to the group/clinic. After the reassignment agreement has been signed, the local Medicare carrier will tie the individual physician ’ s PIN to the group/clinic PIN. When the group/clinic bills Medicare, they must use this provider number when filing for services performed as part of the group.

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